St.

Mary Coptic Orthodox Church of Chicago

Registration Form St. Mark Festival 2015 (Kindergarten through 12 th
grade)
1- Registrants Information:
First Name: ______________________ Last Name: ______________________________
Grade Level for (2014-2015 school year):
_____________________________________________
2- Registrants shirt please check size:
Youth:
Adult :

Small

Medium

Large

Small

Medium

Large

3 - Registrants Personal Health Information

Allergies: ________________________________________________________________
Insurance Information: _____________________________________________________
3- Parent Information:
Parent Name #: ___________________________________________________________
Home Address: ____________________________________________________________
Parent Cell # & Email address: ________________________________________________
Please circle the best way to reach you:
text

phone

email

In the case of an emergency the servants will act in the best interest of
the child.
4- Emergency Contact Information
Emergency 1st Contact Name & Number:
_________________________________________________
Emergency 2nd Contact Name & Number:
________________________________________________
5- Fees & Payment
Fees: $20 (includes Mahragan curriculum book, shirt, and CD w/anthem and hymns)
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Payment Method & Date (please check off) : Cash __________ Check # ____________
****Checks should be made payable to St. Mary Coptic Orthodox Church****
6 - Categories to Participate/ All ages/ Please circle Y or N

Spiritual Studies & Memorization (mandatory all ages)

Coptic Language (mandatory all ages)

Hymns (mandatory all ages)

Arts

Choir -

Y
Y

/
/

N (optional)
N (optional)

Third Grade & up only (all activities below are optional)

Multimedia & Technology

Research Papers

Creative Writing

Y / N

Drama

/ N
/ N

Y / N

Chess

Music (instruments)
_____________________

Y /
Y /

If yes, what instrument

*****Group and pending supervision availability.*****

Sports

Y /

If yes, please circle your option(s):

Ping Pong
Volleyball

N
Basketball

Soccer

Parents Acknowledgement of Responsibility

I understand that my child ________________________________will receive the
best results with my commitment to support him/her through his/her
learning of spiritual material, hymns and the Coptic curriculum by
encouraging him/her to attend all lessons provided.
I also received the guide lines of the activity/activities my child will
participate in MAK 2015.
Parents Signature &
Date:__________________________________________________________
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### Note: 1 copy for family coordinator/main servant(s) and 1 copy for
committee ###

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